Employee Report on Harassment
Please fill out on your device, then download and print the PDF to turn in.
Employee Name
Date of Report
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Position
Date of Alleged Harassment
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Alleged Harassment
Name of Alleged Harasser
Position of Harasser
Department or School of Harasser
Description of Incident(s)
Names of Witness(es), if any
Signature of Person Making The Report
Print
Print
Should be Empty: